Endometriosis is a chronic gynecological disorder defined as the presence of endometrial glands and stroma outside the endometrial cavity, mainly in ovaries, fallopian tubes, cul-de-sac and the uterine ligaments. Theories of endometriosis suggest that its etiology arises from a complex interaction of both genetic and environmental influences. This condition is characterized by peritoneal inflammation, fibrosis, adhesions and ovarian cysts, which result in chronic pelvic pain, pain during intercourse (dyspareunia), painful periods (dysmenorrhea) and infertility. Still today, endometriosis remains a poorly understood condition that continues to incapacitate and affect the productivity and lifestyle of millions of women around the world. Research indicates that stress is a significant component of many recurrent and chronic health problems, including chronic pain disorders. The negative effects of stress on many diseases include impairment of immune function, increasing cortisol levels and alteration of the hormonal balance. It is generally accepted that dealing with the symptoms of endometriosis on a daily basis is stressful by itself. Circumstantial evidence suggests that a variety of stress management techniques, including effectively handling stressful situations and implementing lifestyle changes, can help women suffering from endometriosis and other reproductive disorders. However, whether stress affects the prevalence and progression of endometriosis in women is still unknown. This study will test the hypothesis that stress and its controllability, can affect disease progression and phenotype through different mechanisms, including dysregulation of the immune system and involvement of central pain centers, in an established animal model of endometriosis. The specific aims of this translational study will examine whether stress can exacerbate the development and progression of endometriosis, and determine whether the ability to control stress can decrease the extent of endometriosis. It will contribute to the goals of the AREA program by strengthening the institutional environment through support of an interdisciplinary group of experienced investigators with expertise in endometriosis, animal physiology and behavior. It will provide opportunities for exposure of students at various levels to multidisciplinary research areas, providing a unique training opportunity and further encouraging their continued studies in the biomedical sciences. The results of these studies are also expected to identify possible interventions that will ultimately help women affected by this disease to live healthy and productive lives, in accordance with the mission of the NIH.